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09.08.097:35 PM ET

The Speech of His Life—Again

Liberals are suspicious. The GOP is wailing on him. Congress is paralyzed. Eric Alterman on what’s at stake on health care—and why all is not yet lost.

For a fellow who won a sweeping electoral victory with large majorities in both houses of Congress, Barack Obama may be forgiven for feeling awfully alone out there on Wednesday night. His health-care proposals are under fire not only from the right-wing Republican crazies who compare him to Hitler and demand that he go back to Kenya where they are certain he was born, but from (rare, remaining) Republican moderates, Democratic centrists, and Democratic liberals; in short, everyone.

Republican political consultant Charlie Black told
The New York Times, “If they thought that his popularity and the goodwill he had would support liberal policies, they were wrong.” Thing is, if “they” thought that his popularity and good will would support conservative or moderate policies—as Obama has put forth a dizzying combination of all three during the first nine months of his presidency—they were also wrong. Obama and his advisers have concluded that the liberal base of the Democratic Party does not constitute a sufficient basis for effective governance. He cannot use it as George W. used his—to threaten, to cajole, to harass, and to frighten recalcitrant legislators into line. And so when Congress is involved in the decision, Obama must take whatever deal he can get. Thing is, again, Congress is pretty much dysfunctional when it comes to big issues with a great many institutional and financial interests opposing one another. Throw in the fact that health care involves just about every single American and as much as a fifth of the entire economy and you have a recipe for the same kind of catastrophe that ruined Bill Clinton’s first term and has stymied every Democratic nominee since Harry Truman.

Obama and his advisers have concluded that the liberal base of the Democratic Party does not constitute a sufficient basis for effective governance. He cannot use it as George W. used his—to threaten, to cajole, to harass and to frighten recalcitrant legislators into line.

It is a cliché by now to observe that Obama long ago lost control of this debate. As E.J. Dionne
observes, it’s rather ironic that within the allegedly liberal media, the dominant voice heard on health care “reflects a fringe right-wing view opposed to all sorts of government programs most Americans support. Much as the far left of the antiwar movement commanded wide coverage during the Vietnam years,” he notes, “so now are extremists on the right hogging the media stage—with the media's complicity.” Meanwhile, the people who used to carry out those raucous, often anti-American demonstrations in the '60s could not be better behaved, more mainstream—or less effective. Todd Gitlin attended one of those MoveOn.org-sponsored vigils for health care last week among his fellow “middle-aged or older” liberals and came away
put off by the “parade of victimhood chronicles.”

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Eric Pape: Bring On the Death Panels!“Nothing will influence the perception of the presidency more than whether he can be successful in getting a health-care bill through the Congress,” John Podesta rightly
observes. But while it is a critical moment for the Obama administration to be sure, all is not darkness on the political horizon. According to a memo sent to Hill Democrats by Joel Benenson of the
Benenson Strategy Group on “Public Opinion and the State of Health Insurance Reform,” “By large margins, the American people support major reforms to the health-care system. … A substantial majority of Americans believe that the problems in the country’s health-care system will eventually affect most Americans if they are not addressed. … The desire for change is driven, more than anything else, by a desire to see a crackdown on the worst practices of insurance companies … There is little doubt that the moderate numbers of support for the president’s health-insurance reform plan are based in large part on a lack of awareness of the details of the plan.”

The challenge for the president therefore is to make people aware of what actually is in the plan. Problem is, until tonight, the president hasn’t really had a plan. He's had the various relevant committees in Congress write up competing plans and each time that happened, they came up against their institution's dysfunction. Insurance companies didn’t like this; doctors didn’t like that; unions didn’t like the other thing; and rich people and corporate lobbyists—the people who pay actual attention to details and actual money for election campaigns—didn’t like much of anything.

Health care really is a case, to borrow a phrase from Al Gore, of the people vs. the powerful. Every other democracy in the world, save South Africa, manages to provide decent care to all its citizens, but we cannot because our people are too weak and our powerful too powerful. Bill Clinton learned, to his dismay, that the mainstream media could not be depended upon to communicate the kind of complicated tradeoffs that a health-care reorganization required and did not have the good sense to take half a loaf when it was offered. Obama’s media landscape is far more treacherous than that which thwarted Clinton—a hundred Limbaughs have bloomed and been given cable TV and radio shows—and the president has only himself, the odd policy wonk, and the netroots to make his case for him.

Obama’s reliance on, and distaste for the netroots explains why he has to retain the public option right up until the last minute when he gives it away. Give it away too early and his most devoted supporters will feel betrayed. (More than 60 House Democrats sent Speaker Nancy Pelosi a letter promising, not altogether credibly, to walk away from any bill that does not include a strong public option. "Health-care reform without a good public option is not health-care reform at all,"
says California Rep. Lynn Woolsey. But the base understands that half a loaf is a damn sight better than no loaf and can be built upon in the future. What’s more, the defeat of Obama’s most central priority—he has so far done 28 speeches or events specifically on health care and mentioned his goals for the plan 121 times since becoming president; nearly half of all his speeches and remarks—would mean the defeat of the liberal agenda. Dennis Kucinich is not exactly waiting in the wings to sweep into the presidency on a wave of populist anger next time around.

Going into this speech, Obama had to make a choice between two competing camps in his administration, as The Washington Post policy wonk Ezra Klein
explains. “The first camp could be called "universal-lite." They're focused on preserving the basic shape of the bill. They think a universal plan is necessary… The second camp is not universal at all. This camp believes the bill needs to be scaled back sharply in order to ensure passage. Covering 20 million people isn't as good as covering 40 million people, but it's a whole lot better than letting the bill fall apart.”

The smart money puts Obama in the second camp. That way, he builds for the future and protects himself against a colossal screwup that leaves everybody furious and his presidencyand (not incidentally) progressive hopes for the future of this country in the dumpster. A plan that begins with children and includes catastrophic care for everyone—the two least defensible aspects of our indefensible system—could be expanded, as could taxes on so-called Cadillac plans. (Obama might consider reminding folks that John McCain wanted to tax everybody’s plan!)

One thing’s for sure, to satisfy all these competing requirements—to keep the left on board while quietly letting them down—Obama will have to give the speech of his life… yet again.